MRI Biopsy Targeting Cube with Gripping Arms

ABSTRACT

A biopsy system comprises a control module, a localization assembly, a biopsy device, and a targeting cube. The biopsy device and/or other associated components are configured to selectively couple with a targeting cube that selectively couples with a grid plate having apertures for receiving the targeting cube. The targeting cube comprises a body defined by faces. The targeting cube further comprises guide holes that originate and terminate at the faces and pass through the body of the targeting cube to provide passageways through the targeting cube. To securely and removably fit the targeting cube within a grid plate aperture, the targeting cube also comprises a pair of gripping arms. The gripping arms extend from two opposing faces of the cube and snap fit around the walls of the grid plate to secure the targeting cube in position. The arms are resiliently biased to engage the grid plate.

BACKGROUND

Biopsy samples have been obtained in a variety of ways in variousmedical procedures using a variety of devices. Biopsy devices may beused under stereotactic guidance, ultrasound guidance, MRI guidance, PEMguidance, BSGI guidance, or otherwise. Merely exemplary biopsy devicesare disclosed in U.S. Pat. No. 6,273,862, entitled “Surgical Device forthe Collection of Soft Tissue,” issued Aug. 14, 2001; U.S. Pat. No.6,231,522, entitled “Biopsy Instrument with Breakable Sample Segments,”issued May 15, 2001; U.S. Pat. No. 6,228,055, entitled “Devices forMarking and Defining Particular Locations in Body Tissue,” issued May 8,2001; U.S. Pat. No. 6,120,462, entitled “Control Method for an AutomatedSurgical Biopsy Device,” issued Sep. 19, 2000; U.S. Pat. No. 6,086,544,entitled “Control Apparatus for an Automated Surgical Biopsy Device,”issued Jul. 11, 2000; U.S. Pat. No. 6,077,230, entitled “BiopsyInstrument with Removable Extractor,” issued Jun. 20, 2000; U.S. Pat.No. 6,017,316, entitled “Vacuum Control System and Method for AutomatedBiopsy Device,” issued Jan. 25, 2000; U.S. Pat. No. 6,007,497, entitled“Surgical Biopsy Device,” issued Dec. 28, 1999; U.S. Pat. No. 5,980,469,entitled “Method and Apparatus for Automated Biopsy and Collection ofSoft Tissue,” issued Nov. 9, 1999; U.S. Pat. No. 5,964,716, entitled“Method of Use for a Multi-Port Biopsy Instrument,” issued Oct. 12,1999; U.S. Pat. No. 5,928,164, entitled “Apparatus for Automated Biopsyand Collection of Soft Tissue,” issued Jul. 27, 1999; U.S. Pat. No.5,775,333, entitled “Apparatus for Automated Biopsy and Collection ofSoft Tissue,” issued Jul. 7, 1998; U.S. Pat. No. 5,769,086, entitled“Control System and Method for Automated Biopsy Device,” issued Jun. 23,1998; U.S. Pat. No. 5,649,547, entitled “Methods and Devices forAutomated Biopsy and Collection of Soft Tissue,” issued Jul. 22, 1997;U.S. Pat. No. 5,526,822, entitled “Method and Apparatus for AutomatedBiopsy and Collection of Soft Tissue,” issued Jun. 18, 1996; U.S. Pub.No. 2008/0214955, entitled “Presentation of Biopsy Sample by BiopsyDevice,” published Sep. 4, 2008; U.S. Pub. No. 2007/0255168, entitled“Grid and Rotatable Cube Guide Localization Fixture for Biopsy Device,”published Nov. 1, 2007; U.S. Pub. No. 2007/0118048, entitled “RemoteThumbwheel for a Surgical Biopsy Device,” published May 24, 2007; U.S.Pub. No. 2005/0283069, entitled “MRI Biopsy Device LocalizationFixture,” published Dec. 22, 2005; U.S. Pub. No. 2003/0199753, entitled“MRI Compatible Biopsy Device with Detachable Probe,” published Oct. 23,2003; U.S. Pub. No. 2003/0109803, entitled “MRI Compatible SurgicalBiopsy Device,” published Jun. 12, 2003; U.S. Pub. No. 2008/0221480,entitled “Biopsy Sample Storage,” published Sep. 11, 2008; and U.S. Pub.No. 2008/0146962, entitled “Biopsy System with Vacuum Control Module,”published Jun. 19, 2008. The disclosure of each of the above-cited U.S.patents and U.S. patent application Publications is incorporated byreference herein.

Some biopsy systems may provide an apparatus to guide a probe and/orother components of a biopsy device to a desired biopsy site. In somesuch biopsy systems, a guide cube and positioning grid plate may beused. The guide cube may be selectively located within an opening in thegrid plate. The guide cube may include guide holes to receive a portionof the probe and/or other components, for example a needle, cannula,obturator, or combinations of these or other components. With the guidecube inserted in the grid plate, the probe or other components can beguided through a selected guide hole of the guide cube to arrive at adesired biopsy site. The desired biopsy site may or may not have beenidentified and/or targeted by one or more of the guidance approachesmentioned above. In some situations, it might be desirable to provide aguide cube with features that improve a guide cube's use with one ormore positioning grid plates. Merely exemplary biopsy device guides aredisclosed in U.S. patent application Ser. No. 12/485,119, entitled“Biopsy Targeting Cube with Elastomeric Edges,” filed Jun. 16, 2009;U.S. patent application Ser. No. 12/485,138, entitled “Biopsy TargetingCube with Elastomeric Body,” filed Jun. 16, 2009; U.S. patentapplication Ser. No. 12/485,168, entitled “Biopsy Targeting Cube withMalleable Members,” filed Jun. 16, 2009; U.S. patent application Ser.No. 12/485,278, entitled “Biopsy Targeting Cube with Angled Interface,”filed Jun. 16, 2009; and U.S. patent application Ser. No. 12/485,318,entitled “Biopsy Targeting Cube with Living Hinges,” filed Jun. 16,2009. The disclosure of each of the above-cited U.S. patent applicationsis incorporated by reference herein.

While several systems and methods have been made and used for obtaininga biopsy sample, it is believed that no one prior to the inventors hasmade or used the invention described in the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim the invention, it is believed the presentinvention will be better understood from the following description ofcertain examples taken in conjunction with the accompanying drawings. Inthe drawings, like numerals represent like elements throughout theseveral views.

FIG. 1 is a perspective view of a biopsy system including a controlmodule remotely coupled to a biopsy device, and including a localizationassembly.

FIG. 2 is a perspective view of a breast coil of the localizationassembly of FIG. 1.

FIG. 3 is a perspective view of the biopsy device inserted through theguide cube of the localization assembly of FIG. 1.

FIG. 4 is a perspective view of the obturator and cannula of the biopsysystem of FIG. 1.

FIG. 5 is an exploded perspective view of the obturator and cannula ofFIG. 4.

FIG. 6 is a perspective view of the guide cube inserted into the gridplate of the localization assembly of FIG. 1.

FIG. 7 is a perspective view of the obturator and cannula of FIG. 4 witha depth stop device of FIG. 1 inserted through the guide cube and gridplate of FIG. 6.

FIG. 8 is a perspective view of the guide cube of the biopsy system ofFIG. 1.

FIG. 9 is a diagram of nine guide positions achievable by rotating theguide cube of FIG. 8.

FIG. 10 is a perspective view of another guide cube for the biopsysystem of FIG. 1 with a self-grounding feature.

FIG. 11 is a perspective view of the obturator and cannula of FIG. 1inserted into one of two guide cubes of FIG. 10 inserted into the gridplate of FIG. 1.

FIG. 12 is a perspective view of another exemplary guide cube having anopen top and bottom with another self-grounding feature.

FIG. 13 is a rear perspective view of another exemplary guide cube withanother self-grounding feature.

FIG. 14 is a front perspective view of the guide cube of FIG. 13.

FIG. 15 is a right side view of the guide cube of FIG. 13 with angled,parallel guide holes depicted in phantom.

FIG. 16 is a front perspective view of another exemplary guide cube,with gripping arms.

FIG. 17 is a rear perspective view of the guide cube of FIG. 16.

FIG, 18 is a bottom plan view of the guide cube of FIG. 16.

FIG. 19 is a perspective view of the guide cube of FIG. 16 inserted intoa grid plate of a localization assembly.

FIG. 20 is a top plan view of the guide cube of FIG. 16 inserted into agrid plate of a localization assembly, with part of the grid plate shownin cross-section, and with locking arms of the guide cube engaged withthe grid plate.

FIG. 21 is a top plan view of the guide cube of FIG. 16 inserted into agrid plate of a localization assembly, with part of the grid plate shownin cross-section, and with locking arms of the guide cube disengagedfrom the grid plate.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the invention may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presentinvention, and together with the description serve to explain theprinciples of the invention; it being understood, however, that thisinvention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples should not be used tolimit the scope of the present invention. Other features, aspects, andadvantages of the versions disclosed herein will become apparent tothose skilled in the art from the following description, which is by wayof illustration, one of the best modes contemplated for carrying out theinvention. As will be realized, the versions described herein arecapable of other different and obvious aspects, all without departingfrom the invention. Accordingly, the drawings and descriptions should beregarded as illustrative in nature and not restrictive.

As shown in the figures, an exemplary magnetic resonance imaging (MRI orMR imaging) compatible biopsy system may include a control module (12),localization assembly (15), and biopsy device (14). In particular,localization assembly (15) is configured to localize a patient's breastand guide needle (90) of biopsy device (14) to a targeted area withinthe patient's breast; while control module (12) is operable to controlbiopsy device (14) after needle (90) has been introduced to the targetsite. These components and their sub-components will be discussedfurther below. In addition, guide cubes for use with variouslocalization assemblies will be discussed. While this disclosure mayreference the biopsy system as compatible with MRI and MRI equipment anddevices, it should be appreciated that other imaging techniques andequipment and devices may be used with the components described below,including but not limited to stereotactic, ultrasound, PEM, BSGI, and/orother imaging techniques and equipment.

I. Control Module

In FIGS. 1-3, MRI compatible biopsy system (10) has control module (12)that may be placed outside of a shielded room containing an MRI machine(not shown) or at least spaced away to mitigate detrimental interactionwith its strong magnetic field and/or sensitive radio frequency (RF)signal detection antennas. As described in U.S. Pat. No. 6,752,768,which is hereby incorporated by reference in its entirety, a range ofpreprogrammed functionality may be incorporated into control module (12)to assist in taking tissue samples. Control module (12) controls andpowers biopsy device (14) that is used with localization assembly (15).Biopsy device (14) is positioned and guided by localization fixture (16)attached to breast coil (18) that may be placed upon a gantry (notshown) of a MRI or other imaging machine.

In the present example, control module (12) is mechanically,electrically, and pneumatically coupled to biopsy device (14) so thatcomponents may be segregated that need to be spaced away from the strongmagnetic field and the sensitive RF receiving components of a MRImachine. Cable management spool (20) is placed upon cable managementattachment saddle (22) that projects from a side of control module (12).Wound upon cable management spool (20) is paired electrical cable (24)and mechanical cable (26) for communicating control signals and cutterrotation/advancement motions respectively. In particular, electrical andmechanical cables (24, 26) each have one end connected to respectiveelectrical and mechanical ports (28, 30) in control module (12) andanother end connected to holster portion (32) of biopsy device (14).Docking cup (34), which may hold holster portion (32) when not in use,is hooked to control module (12) by docking station mounting bracket(36). It should be understood that such components described above asbeing associated with control module (12) are merely optional.

Interface lock box (38) mounted to a wall provides tether (40) tolockout port (42) on control module (12). Tether (40) is uniquelyterminated and of short length to preclude inadvertent positioning ofcontrol module (12) too close to a MRI machine or other machine. In-lineenclosure (44) may register tether (40), electrical cable (24) andmechanical cable (26) to their respective ports (42, 28, 30) on controlmodule (12).

Vacuum assist is provided by first vacuum line (46) that connectsbetween control module (12) and outlet port (48) of vacuum canister (50)that catches liquid and solid debris. Tubing kit (52) completes thepneumatic communication between control module (12) and biopsy device(14). In particular, second vacuum line (54) is connected to inlet port(56) of vacuum canister (50). Second vacuum line (54) divides into twovacuum lines (58, 60) that are attached to biopsy device (14). Withbiopsy device (14) installed in holster portion (32), control module(12) performs a functional check. Saline may be manually injected intobiopsy device (14) or otherwise introduced to biopsy device (14), suchas to serve as a lubricant and to assist in achieving a vacuum sealand/or for other purposes. Control module (12) actuates a cuttermechanism (not shown) in biopsy device (14), monitoring full travel of acutter in biopsy device (14) in the present example. Binding inmechanical cable (26) or within biopsy device (14) may optionallymonitored with reference to motor force exerted to turn mechanical cable(26) and/or an amount of twist in mechanical cable (26) sensed incomparing rotary speed or position at each end of mechanical cable (26).

Remote keypad (62), which is detachable from holster portion (32),communicates via electrical cable (24) to control panel (12) to enhanceclinician control of biopsy device (14) in the present example,especially when controls that would otherwise be on biopsy device (14)itself are not readily accessible after insertion into localizationfixture (16) and/or placement of control module (12) is inconvenientlyremote (e.g., 30 feet away). However, as with other components describedherein, remote keypad (62) is merely optional, and may be modified,substituted, supplemented, or omitted as desired. In the presentexample, aft end thumbwheel (63) on holster portion (32) is also readilyaccessible after insertion to rotate the side from which a tissue sampleis to be taken.

Of course, the above-described control module (12) is merely oneexample. Any other suitable type of control module (12) and associatedcomponents may be used. By way of example only, control module (12) mayinstead be configured and operable in accordance with the teachings ofU.S. Pub. No. 2008/0228103, entitled “Vacuum Timing Algorithm for BiopsyDevice,” published Sep. 18, 2008, the disclosure of which isincorporated by reference herein. As another merely illustrativeexample, control module (12) may instead be configured and operable inaccordance with the teachings of U.S. patent application Ser. No.12/337,814, entitled “Control Module Interface for MRI Biopsy Device,”filed December 18, 2008, the disclosure of which is incorporated byreference herein. Alternatively, control module (12) may have any othersuitable components, features, configurations, functionalities,operability, etc. Other suitable variations of control module (12) andassociated components will be apparent to those of ordinary skill in theart in view of the teachings herein.

II. Localization Assembly

Localization assembly (15) of the present example comprises breast coil(18) and localization fixture (16). These components of localizationassembly (15) are described further below.

Left and right parallel upper guides (64, 66) of localization framework(68) are laterally adjustably received respectively within left andright parallel upper tracks (70, 72) attached to under side (74) and toeach side of a selected breast aperture (76) formed in patient supportplatform (78) of breast coil (18). Base (80) of breast coil (18) isconnected by centerline pillars (82) that are attached to patientsupport platform (78) between breast apertures (76). Also, a pair ofouter vertical support pillars (84, 86) on each side spaced about arespective breast aperture (76) respectively define lateral recess (88)within which localization fixture (16) resides.

It should be appreciated that the patient's breasts hang pendulouslyrespectively into breast apertures (76) within lateral recesses (88) inthe present example. For convenience, herein a convention is used forlocating a suspicious lesion by Cartesian coordinates within breasttissue referenced to localization fixture (16) and to thereafterselectively position an instrument, such as needle (90) of probe (91)that is engaged to holster portion (32) to form biopsy device (14). Ofcourse, any other type of coordinate system or targeting techniques maybe used. To enhance hands-off use of biopsy system (10), especially forrepeated re-imaging within the narrow confines of a closed bore MRImachine, biopsy system (10) may also guide obturator (92) encompassed bycannula (94). Depth of insertion is controlled by depth stop device (95)longitudinally positioned on either needle (90) or cannula (94).Alternatively, depth of insertion may be controlled in any othersuitable fashion.

This guidance is specifically provided by a lateral fence in the presentexample, depicted as grid plate (96), which is received within laterallyadjustable outer three-sided plate bracket (98) attached below left andright parallel upper guides (64, 66). Similarly, a medial fence withrespect to a medial plane of the chest of the patient, depicted asmedial plate (100), is received within inner three-sided plate bracket(102) attached below left and right parallel upper guides (64, 66) closeto centerline pillars (82) when installed in breast coil (18). Tofurther refine the insertion point of the instrument (e.g., needle (90)of probe (91), obturator/cannula (92, 94), etc.), guide cube (104) maybe inserted into grid plate (96).

In the present example, the selected breast is compressed along an inner(medial) side by medial plate (100) and on an outer (lateral) side ofthe breast by grid plate (96), the latter defining an X-Y plane. TheX-axis is vertical (sagittal) with respect to a standing patient andcorresponds to a left-to-right axis as viewed by a clinician facing theexternally exposed portion of localization fixture (16). Perpendicularto this X-Y plane extending toward the medial side of the breast is theZ-axis, which typically corresponds to the orientation and depth ofinsertion of needle (90) or obturator/cannula (92, 94) of biopsy device(14). For clarity, the term Z-axis may be used interchangeably with“axis of penetration”, although the latter may or may not be orthogonalto the spatial coordinates used to locate an insertion point on thepatient. Versions of localization fixture (16) described herein allow anon-orthogonal axis of penetration to the X-Y axis to a lesion at aconvenient or clinically beneficial angle.

It should be understood that the above-described localization assembly(15) is merely one example. Any other suitable type of localizationassembly (15) may be used, including but not limited to localizationassemblies (15) that use a breast coil (18) and/or localization fixture(16) different from those described above. Other suitable components,features, configurations, functionalities, operability, etc. for alocalization assembly (15) will be apparent to those of ordinary skillin the art in view of the teachings herein.

III. Biopsy Device

As shown in FIG. 1, one version of biopsy device (14) may compriseholster portion (32) and probe (91). Exemplary holster portion (32) wasdiscussed previously in the above section addressing control module(12). The following paragraphs will discuss probe (91) and associatedcomponents and devices in further detail.

In the present example, cannula (94) and obturator (92) are associatedwith probe (91). In particular, and as shown in FIGS. 4, 5, and 7,obturator (92) is slid into cannula (94) and the combination is guidedthrough guide cube (104) to the biopsy site within the breast tissue.Obturator (92) is then withdrawn from cannula (94), then needle (90) ofprobe (91) is inserted in cannula (94), and then biopsy device (14) isoperated to acquire one or more tissue samples from the breast vianeedle (90).

Cannula (94) of the present example is proximally attached tocylindrical hub (198) and cannula (94) includes lumen (196) and lateralaperture (200) proximate to open distal end (202). Cylindrical hub (198)has exteriorly presented thumbwheel (204) for rotating lateral aperture(200). Cylindrical hub (198) has interior recess (206) that encompassesduckbill seal (208), wiper seal (210) and seal retainer (212) to providea fluid seal when lumen (196) is empty and for sealing to insertedobturator (92). Longitudinally spaced measurement indicia (213) along anouter surface of cannula (94) visually, and perhaps physically, providea means to locate depth stop device (95) of FIG. 1.

Obturator (92) of the present example incorporates a number ofcomponents with corresponding features. Hollow shaft (214) includesfluid lumen (216) that communicates between imageable side notch (218)and proximal port (220). Hollow shaft (214) is longitudinally sized toextend, when fully engaged with cannula (94), piercing tip (222) out ofdistal end (202) of cannula (94). Obturator thumbwheel cap (224)encompasses proximal port (220) and includes locking feature (226),which includes visible angle indicator (228), that engages cannulathumbwheel (204) to ensure that imageable side notch (218) is registeredto lateral aperture (200) in cannula (94). Obturator seal cap (230) maybe engaged proximally into obturator thumbwheel cap (224) to close fluidlumen (216). Obturator seal cap (230) of the present example includeslocking or locating feature (232) that includes visible angle indicator(233) that corresponds with visible angle indicator (228) on obturatorthumbwheel cap (224), which may be fashioned from either a rigid, soft,or elastomeric material. In FIG. 7, guide cube (104) has guidedobturator (92) and cannula (94) through grid plate (96).

While obturator (92) of the present example is hollow, it should beunderstood that obturator (92) may alternatively have a substantiallysolid interior, such that obturator (92) does not define an interiorlumen. In addition, obturator (92) may lack side notch (218) in someversions. Other suitable components, features, configurations,functionalities, operability, etc. for an obturator (92) will beapparent to those of ordinary skill in the art in view of the teachingsherein. Likewise, cannula (94) may be varied in a number of ways. Forinstance, in some other versions, cannula (94) has a closed distal end(202). As another merely illustrative example, cannula (94) may have aclosed piercing tip (222) instead of obturator (92) having piercing tip(222). In some such versions, obturator (92) may simply have a bluntdistal end; or the distal end of obturator (92) may have any othersuitable structures, features, or configurations. Other suitablecomponents, features, configurations, functionalities, operability, etc.for a cannula (94) will be apparent to those of ordinary skill in theart in view of the teachings herein. Furthermore, in some versions, oneor both of obturator (92) or cannula (94) may be omitted altogether. Forinstance, needle (90) of probe (91) may be directly inserted into aguide cube (104), without being inserted into guide cube (104) viacannula (94).

Another component that may be used with probe (91) (or needle (90)) isdepth stop (95). Depth stop may be of any suitable configuration that isoperable to prevent cannula (94) and obturator (92) (or needle (90))from being inserted further than desired. For instance, depth stop (95)may be positioned on the exterior of cannula (94) (or needle (90)), andmay be configured to restrict the extent to which cannula (94) isinserted into a guide cube. It should be understood that suchrestriction by depth stop (95) may further provide a limit on the depthto which the combination of cannula (94) and obturator (92) (or needle(90)) may be inserted into the patient's breast. Furthermore, it shouldbe understood that such restriction may establish the depth within thepatient's breast at which biopsy device (14) acquires one or more tissuesamples after obturator (92) has been withdrawn from cannula (94) andneedle (90) has been inserted in cannula (94). Exemplary depth stops(95) that may be used with biopsy system (10) are described in U.S. Pub.No. 2007/0255168, entitled “Grid and Rotatable Cube Guide LocalizationFixture for Biopsy Device,” published Nov. 1, 2007, and incorporated byreference herein as mentioned previously.

In the present example, and as noted above, biopsy device (14) includesa needle (90) that may be inserted into cannula (94) after thecombination of cannula (94) and obturator (92) has been inserted to adesired location within a patient's breast and after obturator (92) hasbeen removed from cannula (94). Needle (90) of the present examplecomprises a lateral aperture (not shown) that is configured tosubstantially align with lateral aperture (200) of cannula (94) whenneedle (90) is inserted into lumen (196) of cannula (94). Probe (91) ofthe present example further comprises a rotating and translating cutter(not shown), which is driven by components in holster (32), and which isoperable to sever tissue protruding through lateral aperture (200) ofcannula (94) and the lateral aperture of needle (90). Severed tissuesamples may be retrieved from biopsy device (14) in any suitablefashion.

By way of example only, biopsy device (14) may be configured andoperable in accordance with the teachings of U.S. Pub. No. 2008/0228103,entitled “Vacuum Timing Algorithm For Biopsy Device,” published Sep. 18,2008, the disclosure of which is incorporated by reference herein. Asanother merely illustrative example, biopsy device (14) may beconfigured and operable in accordance with the teachings of U.S. patentapplication Ser. No. 12/337,874, entitled “Mechanical Tissue SampleHolder Indexing Device,” filed Dec. 18, 2008, the disclosure of which isincorporated by reference herein. As another merely illustrativeexample, biopsy device (14) may be configured and operable in accordancewith the teachings of U.S. patent application Ser. No. 12/337,674,entitled “Biopsy Device with Sliding Cutter Cover,” filed Dec. 18, 2008,the disclosure of which is incorporated by reference herein. By way ofexample only, cannula (94) may be replaced with any of the detachableneedles described in U.S. patent application Ser. No. 12/337,674,entitled “Biopsy Device with Sliding Cutter Cover.” As another merelyillustrative example, biopsy device (14) may be configured and operablein accordance with the teachings of U.S. patent application Ser. No.12/337,911, entitled “Biopsy Device with Discrete Tissue Chambers,”filed Dec. 18, 2008, the disclosure of which is incorporated byreference herein. As another merely illustrative example, biopsy device(14) may be configured and operable in accordance with the teachings ofU.S. patent application Ser. No. 12/337,942, entitled “Biopsy Devicewith Central Thumbwheel,” filed Dec. 18, 2008, the disclosure of whichis incorporated by reference herein. Alternatively, biopsy device (14)may have any other suitable components, features, configurations,functionalities, operability, etc. Other suitable variations of biopsydevice (14) and associated components will be apparent to those ofordinary skill in the art in view of the teachings herein

IV. Guide Cubes

Guide cubes described below are generally adapted for use with alocalization assembly (15) as described above. Numerous features ofmerely exemplary guide cubes will be discussed in the paragraphs thatfollow.

A. Guide Cubes Generally

In some versions, guide cubes may comprise a body defined by one or moreedges and faces. The body may include one or more guide holes or othertypes of passages that extend between faces of the guide cube and thatmay be used to guide an instrument such as a biopsy device (14) or aportion of a biopsy device (14) (e.g., needle (90) of biopsy device(14), a combination of cannula (94) and obturator (92), etc.). Guidecubes may be rotatable about one, two, or three axes to position the oneor more guide holes or passages of the guide cube into a desiredposition.

Referring now to FIG. 8, guide cube (104), includes central guide hole(106), corner guide hole (108), and off-center guide hole (110) thatpass orthogonally to one another between respective opposite pairs offaces (112, 114, 116). By selectively rotating guide cube (104) in twoaxes, one pair of faces (112, 114, 116) may be proximally aligned to anunturned position and then the selected proximal face (112, 114, 116)optionally rotated a quarter turn, half turn, or three-quarter turn.Thereby, one of nine guide positions (118, 120 a-120 d, 122 a-122 d) maybe proximally exposed as depicted in FIG. 9. More specifically, centralguide hole (106) may provide for guide position (118), corner guide hole(108) may provide for guide positions (120 a-120 d), and off-centerguide hole (110) may provide for guide positions (122 a-122 d).

In FIG. 6, two-axis rotatable guide cube (104) is sized for insertionfrom a proximal side into one of a plurality of square recesses (130) ingrid plate (96), which are formed by intersecting vertical bars (132)and horizontal bars (134). Guide cube (104) is prevented from passingthrough grid plate (96) by backing substrate (136) attached to a frontface of grid plate (96). Backing substrate (136) includes respectivesquare opening (138) centered within each square recess (130), forminglip (140) sufficient to capture the front face of guide cube (104), butnot so large as to obstruct guide holes (104, 106, 108). The depth ofsquare recesses (130) is less than guide cube (104), thereby exposing aproximal portion (142) of guide cube (104) for seizing and extractionfrom grid plate (96). It will be appreciated by those of ordinary skillin the art based on the teachings herein that backing substrate (136) ofgrid plate (96) may be omitted altogether in some versions. In some suchversions without backing substrate (136) other features of a guide cube,as will be discussed in more detail below, may be used to securely andremovably fit a guide cube within a grid plate. However, such otherfeatures may also be used in combination with a grid plate havingbacking substrate (136), such as grid plate (96), instead of partiallyor wholly omitting backing substrate (136).

B. Self-Grounding Guide Cubes

In FIG. 10, guide cube (104 a) has self-grounding by means of addedrectangular prism (240) which has a shared edge with cubic portion (242)of guide cube (104 a). When viewed orthogonally to the shared cube edge,larger square face (244) of cubic portion (242) overlaps with smallersquare face (246) of rectangular prism (240). As shown in FIG. 11,rectangular prism (240) allows proximal exposure of one of two adjacentfaces (250, 252) of guide cube (104 a) and then turning each to one offour quarter-turn rotational positions. In the illustrative version,first face (250) has central guide hole (106 a) and second face (252)has corner guide hole (108 a), and off-center guide hole (110 a). Radialrecess (254) is formed in rectangular prism (240) to allow grounding ofdepth stop device (95) against face (252) when off-center guide hole(110 a) is used.

In FIG. 12, guide cube (104 b) has self-grounding by means of addedrectangular prism (260) that protrudes from two faces (262, 264) ofguide cube (104 b). Rectangular prism (260) allows proximal exposure ofone of two adjacent faces (262, 264) of guide cube (104 b) and thenturning each to one of four quarter-turn rotational positions. In theillustrative version, first face (262) has central guide hole (106 b)and second face (264) has corner guide hole (108 b) and off-center guidehole (110 b). First radial recess (266) is formed in rectangular prism(260) to allow grounding of depth stop device (95) against face (264)when off-center guide hole (110 b) is used. Second radial recess (268)is formed in rectangular prism (260) to allow grounding of depth stopdevice (95) against face (262) when central guide hole (106 b) is used.As discussed in greater detail below, guide cube (104 b) may have opentop (261) and/or an open bottom (not shown) defined by the faces ofguide cube (104 b) as depicted in the illustrated version.

In FIGS. 13-15, guide cube (104 c) has proximal enlarged hat portion(270) about proximal face (271) that grounds against selected squarerecess (130), such as in grid plate (96), and allows rotation about oneaxis to one of four quarter-turn positions. Four angled guide holes (272a, 272 b, 272 c, 272 d) allow accessing not only an increased number ofinsertion points within selected square recess (130) but also a desiredangle of penetration rather than being constrained to a perpendicularinsertion. It will be appreciated based on the teachings herein thatwhile angled guide holes may be used in some versions, orthogonal guideholes may be used instead of or in addition to angled guide holes inother versions.

C. Gripping Arms

In some versions of guide devices, the guide device may include featuresthat assist in securing the guide device within an aperture of a gridplate. Such features may be configured to secure the guide device frommovement in a proximal direction, distal direction, lateral direction,or combinations of these or other directions. For instance, suchfeatures may substantially retain the guide device by providingrestriction on or resistance to movement of the guide device relative tothe grid plate (96) upon sufficient engagement between the guide deviceand grid plate (96). In some versions of guide devices, the guidedevices may further include features that assist in securing aninstrument, such as a biopsy device (14) or a portion of a biopsy device(14) (e.g., needle (90) of biopsy device (14), a combination of cannula(94) and obturator (92), etc.), within a selected guide hole orpassageway of the guide device. In some versions, such features maysubstantially retain the instrument or portion of the instrument byproviding resistance to movement of the instrument in a proximaldirection, distal direction, rotational direction, lateral direction, orcombinations of these or other directions. The paragraphs that followwill describe merely exemplary versions of guide devices ormodifications to guide devices that may include some of these optionalfeatures, among features.

As shown in FIGS. 16-21, another exemplary guide cube (304) includes abody (305) that is defined by six faces (306, 308, 310, 312, 314, 316).Of course, body (305) may be defined by a greater or fewer number offaces as will be appreciated by one of ordinary skill in the art. By wayof example only, body (305) may comprise just two faces positionedperpendicular to each other to form a bracket-like structure.Alternatively, body (305) may comprise three faces, where two faces aregenerally opposed in parallel fashion and the third face is positionedat right angles between the two opposed faces. Other suitable numbersand arrangements of faces will be apparent to those of ordinary skill inthe art in view of the teachings herein. In the present example, guidecube (304) further comprises corner guide hole (318) and off-centerguide hole (320), each of which extend between opposite faces (308) and(314). As with other guide holes described herein, guide holes (318,320) provide passageways configured to permit insertion of an instrument(e.g., needle (90) of probe (91), obturator/cannula (92, 94), etc.)through body (305), such that a selected guide hole (318, 320) mayprovide an insertion guide for the instrument at a selected position andorientation.

In addition to body (305), guide cube (304) of the present example alsocomprises a pair of arms (322, 324) that extend from faces (310, 312)respectively to securely and removably fit guide cube (304) within agrid plate (96). Although shown with two arms (322, 324), it will beunderstood that guide cube (304) may comprise any suitable number ofarms to secure the cube (304) within a grid plate (96). By way ofexample only, guide cube (304) may have just one single arm, four arms,or any other suitable number of arms. Because arms (322, 324) areidentical in structure and function in the present example, theremainder of this application will refer only to arm (322) for ease ofdescription, except where a distinction is necessary.

As illustrated in FIGS. 16-21, arm (322) has a generally planarrectangular shape having a first end (326) and a second end (328). Thefirst end (326) comprises a curved flange (330), which, when squeezedwith and toward the corresponding curved flange (332) of arm (324), mayrelease guide cube (304) from a grid plate (96). Flanges (330, 332) maybe curved outwardly with a configuration that accommodates thepositioning of a user's thumb and forefinger, for example. Of course,flanges (330, 332) may alternatively have any other suitableconfiguration. The second end (328) of arm (322) comprises an inwardlyextending ridge (334) that secures guide cube (304) to a grid plate byat least partially surrounding or otherwise engaging the vertical and/orhorizontal bars (132, 134) of the grid plate (96). In the illustrativeversion, arms (322, 324) extend to approximately the same length asfaces (310, 312) so that the ridges (334, 336) of arms (322, 324) arepositioned generally at an outer edge (307) of the guide cube body(305). Of course, the above-described arms (322, 324) are merely oneexample. It will be understood that the dimensions and position of arms(322, 324), especially in relation to the body (305) of guide cube(304), may be varied in any suitable fashion. By way of example only,arms (322, 324) may extend only to approximately midway or three-fourthsof the way along faces (310, 312); or may extend to a greater lengththan faces (310, 312).

Arms (322, 324) extend from the guide cube body (305) via ribs (338,340) in the present example. Ribs (338, 340) may be integrally formed(e.g., molded, etc.) with cube body (305) or they may be attached tobody (305) by way of a fastener (e.g., screw, glue, etc.), by asnap-fit, by an interference fit, or in any other suitable fashion. Ifnot integrally formed with body (305), ribs (338, 340), and thereforearms (322, 324), may be readily detachable from the body (305) in someversions. As shown in FIG. 18, ribs (338, 340) space arms (322, 324)apart from the corresponding faces (310, 312) of body (305), such thatgaps (358, 360) are provided between arms (322, 324) and thecorresponding faces (310, 312). In the present example, these gaps (358,360) are large enough to accommodate horizontal or vertical bars (132,134) of grid plate (96) when body (305) is inserted in a selected recess(130) of grid plate (96).

When body (305) is inserted to a sufficient depth in a selected recess(130) of grid plate (96), as is shown in FIGS. 19-21, ribs (338, 340)may engage horizontal or vertical bars (132, 134) of grid plate (96),such that ribs (338, 340) may provide a grounding feature to restrictthe depth of insertion (in the z-direction shown in FIG. 19).Furthermore, the distance between ribs (338, 340) and the correspondingridge (334, 336) is approximately equal to the depth of horizontal andvertical bars (132, 134) of grid plate (96) (in the z-direction shown inFIG. 19). Accordingly, engagement of ribs (338, 340) with the front ofhorizontal or vertical bars (132, 134) and engagement of ridges (334,336) with the rear of horizontal or vertical bars (132, 134) mayrestrict longitudinal movement of body (305) in either longitudinaldirection when body (305) is inserted in a selected recess (130) of gridplate (96).

In addition to connecting arms (322, 324) to cube body (305), ribs (338,340) of the present example also serve as pivot points such that, whencurved flanges (330, 332) of arms (322, 324) are squeezed or compressedtoward one another, the second end (328) of arms (322, 324) are forcedaway from the cube body (305). In other words, arms (322, 324) arepivotable about ribs (338, 340), as shown in FIGS. 20-21. When flanges(330, 332) of arms (322, 324) are squeezed or compressed toward oneanother, thereby pivoting arms (332, 324) about ribs (338, 340), ridges(334, 336) may become disconnected from the vertical and/or horizontalbars (132, 134) of the grid plate (96). Ribs (338, 340) and arms (322,324) are configured such that arms (322, 324) are resiliently biased toassume a position that is substantially parallel to faces (310, 312),which is the position shown in FIGS. 16-20. Therefore, ridges (334, 336)are resiliently biased to a position where ridges (334, 336) engage withhorizontal or vertical bars (132, 134) of grid plate (96); and outwardseparation of ridges (334, 336) to disengage horizontal or vertical bars(132, 134) by squeezing curved flanges (330, 332) toward each otheragainst this resilient bias.

Referring to FIGS. 19-21, guide cube (304) may be inserted into a gridplate (96) to define the insertion point and/or insertion angle of aninstrument (e.g., needle (90) of probe (91), obturator/cannula (92, 94),etc.) used to perform a biopsy. For example, guide cube (304) may beinserted on the medial side (i.e., side facing the breast tissue) ofgrid plate (96). Alternatively, guide cube (304) may be inserted on thelateral side of grid plate (96). Guide cube (304) fits into a squarerecess (130) of grid plate (96) by positioning the vertical bars (132)that define the recess (130) into the gaps (358, 360) between the arms(322, 324) and cube body (305). In some versions, as shown in FIG. 18,the distal edges of ridges (334, 336) are curved, such that ridges (334,336) may be deflected outwardly by vertical bars (132) as cube (304) isbeing inserted in recess (130). Of course, ridges (334, 336) may haveany other suitable configuration. In addition or in the alternative, thecurved flanges (330, 332) may be squeezed towards each other to avoidinterference between vertical bars (132) and ridges (334, 336), toposition vertical bars (132) within the gaps (358, 360).

Once cube (304) is in position, ridges (334, 336) at least partiallysurround and engage with the rear of the vertical bars (132) of gridplate (96) to secure the guide cube (304) within the recess (130) ofplate (96), as shown in FIG. 20. In the illustrated version, with thearms (322, 324) extending to approximately the same length as faces(310, 312) so that the ridges (334, 336) are positioned generally at anouter edge (307) of guide cube body (305), body (305) will beapproximately flush with grid plate (96) when inserted. Of course, anyother suitable relative sizing of arms (322, 324), body (305) and gridplate (96) may be used. For instance, if arms (322, 324) are shorterthan the length of faces (310, 312), a portion of cube body (305) mayextend from grid plate (96). Arms (322, 324) may also be longer than thelength of faces (310, 312) such that, when inserted, bars (132, 134)defining recess (130) extend proximally beyond the proximal face (308)of cube body (305). To remove guide cube (304) from grid plate (96), thecurved flanges (330, 332) may be squeezed towards each other to causeridges (334, 336) to release bars (132), as shown in FIG. 21. Guide cube(304) may then be pulled proximally out of the grid plate (96) forremoval.

It should be understood that the above-described guide cube (304) ismerely one example. Any other suitable type of guide cube (304) andassociated components may be used. By way of example only, guide cube(304) may include any suitable arrangement of guide holes and need notbe limited to only including a corner hole (318) and off-center hole(320) as in the illustrated version. In some versions, guide cube (304)may include only a central guide hole. In some other versions, guidecube (304) may include one or more guide holes on one or more cubefaces, and guide cube (304) may be rotatable to provide for alternateguide hole orientations. For example, although the illustrated versionshows a guide cube (304) secured to vertical bars (132) of the gridplate (96), guide cube (304) may be rotated 90 or 270 degrees to securethe cube (304) to horizontal bars (134) of the grid plate (96) instead.In still other versions, guide cube (304) comprises slits or similarfeatures instead of guide holes (318, 320), to provide a passagewaybetween opposing faces. It is also noted that guide cube (304) may beformed of a substantially rigid material, of an elastomeric material,and/or of any other suitable material, including combinations ofmaterials. It should also be understood that any other guide cubedescribed herein, and variations thereof, may include one or more arms(322, 324) if desired.

In some versions, guide holes (318, 320) may each include one or moreelastomeric retainers (not shown). Such retainers may be positionedwithin guide holes (318, 320) and/or at the entry of guide holes at face(308) or face (314). By way of example only, such elastomeric retainersmay comprise an o-ring, a duckbill seal, or some other structure. Suchelastomeric retainers may be configured to substantially seal off breasttissue from the instrument (e.g., needle (90) of probe (91),obturator/cannula (92, 94), etc.) that is inserted into the guide hole(318, 320) to maintain a sterile environment. In addition or in thealternative, such retainers may be operatively configured to assist insecuring an instrument such as a biopsy device (14) or a portion of abiopsy device (14) (e.g., needle (90) of biopsy device (14), acombination of cannula (94) and obturator (92), etc.) within a selectedguide hole (318, 320). In particular, retainers may be configured suchthat the opening defined by the combination of the retainer and itscorresponding guide hole (318, 320) is smaller in diameter than thediameter of the instrument, e.g. cannula (94), that is to be inserted ina selected guide hole (318, 320). When cannula (94) is inserted in aselected guide hole (318, 320), the retainer may compress, deform,and/or fold over to provide for a secure fit. In other words, a retainerpermits distal insertion of cannula (94) or needle (90), etc., through aselected guide hole (318, 320), friction between the inserted instrumentand the elastomeric material of retainer provides some resistance toproximal movement of the inserted instrument relative to guide hole(318, 320). In some versions, the securing force provided the retaineris such that the compressed tissue of a patient will not displacecannula (94) proximally from guide hole (318, 320) during a biopsyprocedure. Retainers may thus provide resistance against proximalwithdrawal of the instrument.

It should also be understood that each guide hole (318, 320) may havemore than one associated retainer. For instance, each guide hole (318,320) may have two or more retainers that are axially staggered along thelength of guide hole (318, 320).

While retainers are described as a feature providing resistance towithdrawal of an inserted instrument from guide cube (304) while notsignificantly providing resistance to insertion of the instrument intoguide cube (304), it should be understood that a variety of othercomponents or features may be used to provide similar results.Similarly, it should be understood that retainers may be modified orvaried in numerous ways, if not be omitted altogether. Various ways inwhich retainers may be modified, varied, substituted, or supplementedwill be apparent to those of ordinary skill in the art in view of theteachings herein.

Based on the teachings herein, those of ordinary skill in the art willappreciate that several elastomeric materials may be suitable for usewith guide cube (304), including but not limited to the use ofelastomeric materials to form retainers. Such elastomeric materials maybe used to form at least part of the body (305) of guide cube (304), toenhance friction at ridges (334, 336), to enhance friction at flanges(330, 332), to enhance friction at the inner surfaces of arms (322,324), and/or to form other components of guide cube (304). By way ofexample only, suitable elastomeric materials may include thermosettingplastics that may require vulcanization, thermoplastic elastomers (e.g.Santoprene™ among others), natural rubber, synthetic rubbers (e.g.ethylene propylene diene M-class—EPDM—among others), and other polymershaving suitable elastic properties. Other suitable elastomeric materialswill be apparent to those of ordinary skill in the art in view of theteachings herein. Similarly, other suitable properties that materialsforming various parts of guide cube (304) may have will be apparent tothose of ordinary skill in the art in view of the teachings herein.

Creating a guide cube (304) having elastomeric retainers and/or otherelastomeric components/features may be accomplished in a variety ofways. For example, in creating a guide cube such as a guide cube (304)that has elastomeric retainers, in some versions a multi-shot moldingprocess may be used where the body of guide cube (304) may be moldedfrom a first material, e.g. a non-elastomeric material such as hardplastic, and the elastomeric retainers may be molded from a secondmaterial, e.g. an elastic material as described herein or otherwise. Insome other versions, elastomeric retainers may be molded or extrudedseparate from the body of guide cube (304) and then coupled with thebody of guide cube (304) by mechanical fastening, chemical adhesive, orother suitable bonding or coupling techniques. For instance, guide cube(304) may be molded of substantially hard plastic material, with slotsor recesses formed in guide holes (318, 320) to receive annularelastomeric retainers. Retainers, being separately formed of anelastomeric material, may then be inserted and secured in these slots orrecesses. In some other versions, guide cube (304) with retainers may bemolded as a single unitary piece having a uniform composition ofelastomeric material. Various other suitable ways in which elastomericretainers and/or other elastomeric components/features may beincorporated into guide cube (304) before, during, or aftermanufacturing processes will be apparent to those of ordinary skill inthe art in view of the teachings herein.

It should be understood that any feature(s) and/or operability describedherein with respect to one particular guide cube or device (104, 104 a,104 b, 104 c, 304) may be incorporated into any other guide cube ordevice (104, 104 a, 104 b, 104 c, 304) described herein. By way ofexample only, any of guide cubes or devices (104, 104 a, 104 b, 104 c)may be modified to include arms (322, 324) (or variations thereof)and/or retainers similar to guide cube (304). Similarly, any guide cubeor device (104, 104 a, 104 b, 104 c, 304) described herein may be usedin accordance with the exemplary uses taught herein with respect to oneparticular guide cube or device (104, 104 a, 104 b, 104 c, 304)described herein. Therefore, none of the teachings herein should beunderstood as applying to only one particular version or embodiment ofguide cube or device (104, 104 a, 104 b, 104 c, 304) described herein.Every teaching herein is contemplated as being interchangeable amongversions and embodiments, such that every teaching herein may be appliedto any guide cube or device (104, 104 a, 104 b, 104 c, 304) describedherein. Various ways in which the teachings herein may be interchangedamong various versions and embodiments will be apparent to those ofordinary skill in the art in view of the teachings herein.

As noted above, any guide cube or device (104, 104 a, 104 b, 104 c, 304)described herein may be used in a procedure that includes the use of PEMimaging, BSGI imaging, or any other suitable type of imaging. By way ofexample only, a guide cube or device (104, 104 a, 104 b, 104 c, 304) maybe used with a grid plate (96) that is configured for use in an MRIsetting, a grid plate for use in a nuclear/molecular imaging setting, orwith some other type of cube holder (e.g., “guide holder”) used innuclear/molecular imaging or other type of imaging. For instance, asuitable alternative cube holder or “guide holder” may include feweropenings (e.g., one to four) that are configured to receive a guide cubeor device (104, 104 a, 104 b, 104 c, 304) as compared to the number ofrecesses (130) in grid plate (96). Furthermore, a guide cube or device(104, 104 a, 104 b, 104 c, 304) may be used with a biopsy device (14) inconjunction with a full targeting set or with just a biopsy device (14)(e.g., in settings where a radioisotope can be communicated through thebiopsy device (14)). It should also be understood that a guide cube ordevice (104, 104 a, 104 b, 104 c, 304) may be used just with aradioisotope, without necessarily involving any biopsy device (14). Forinstance, a radioisotope may be provided on or through an implement thathas a sharp tip, and the implement may be inserted through the guidecube or device (104, 104 a, 104 b, 104 c, 304). Still other varioussettings and combinations in which a guide cube or device (104, 104 a,104 b, 104 c, 304) may be used will be apparent to those of ordinaryskill in the art in view of the teachings herein.

While several guide cubes have been discussed in detail above, it shouldbe understood that the components, features, configurations, and methodsof using the guide cubes discussed are not limited to the contextsprovided above. In particular, components, features, configurations, andmethods of use described in the context of one of the guide cubes may beincorporated into any of the other guide cubes. One merely exemplaryadditional feature that may be provided in any of the guide cubesdescribed herein is one or more ridges on one or more external faces ofthe cube. Such ridges may be substantially rigid, elastomeric, or haveany other suitable properties. Such ridges may provide a more secure fitbetween a cube and grid (e.g., reducing the likelihood that that theguide cube will undesirably fall out of the grid plate), may permit asingle cube to be inserted in different grids having differently sizedopenings, and/or may provide other results. Still other additional andalternative suitable components, features, configurations, and methodsof using the guide cubes will be apparent to those of ordinary skill inthe art in view of the teachings herein.

Versions of the present invention have application in conventionalendoscopic and open surgical instrumentation as well as application inrobotic-assisted surgery.

Versions of the devices disclosed herein can be designed to be disposedof after a single use, or they can be designed to be used multipletimes. Versions may, in either or both cases, be reconditioned for reuseafter at least one use. Reconditioning may include any combination ofthe steps of disassembly of the device, followed by cleaning orreplacement of particular pieces, and subsequent reassembly. Inparticular, embodiments of the device may be disassembled, and anynumber of the particular pieces or parts of the device may beselectively replaced or removed in any combination. Upon cleaning and/orreplacement of particular parts, embodiments of the device may bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device mayutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various versions in the present disclosure,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, versions, geometries, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

1. A guide device for guiding a medical instrument relative to apatient, the guide device being usable with a first plate and a secondplate, wherein the first plate has a plurality of apertures defined by aplurality of intersecting walls, wherein the second plate and the firstplate are adjustable to secure a portion of the patient, wherein theguide device is configured to be coupled with a selected one of theapertures of the first plate, the guide device comprising: a. a bodyhaving a generally proximal side, a generally distal side, and a firstgenerally lateral side extending between the generally proximal side andthe generally distal side; b. at least one passageway, wherein the atleast one passageway extends from the generally proximal side of thebody to the generally distal side of the body, wherein the at least onepassageway is configured to receive at least a portion of the medicalinstrument; and c. a first arm extending from the first generallylateral side, wherein the first arm is operable to selectively engagewith a first wall defining the selected one of the apertures in thefirst plate to selectively secure the body to the first plate.
 2. Theguide device of claim 1, further comprising a rib coupling the first armwith the first generally lateral side, wherein the first arm is spacedapart from the first generally lateral side by the rib, such that therib provides a gap between the first arm and the first generally lateralside.
 3. The guide device of claim 2, wherein the gap is configured toreceive the first wall defining the selected one of the apertures in thefirst plate.
 4. The guide device of claim 3, wherein the rib isconfigured to restrict an insertion depth of the body into the selectedone of the apertures in the first plate by engaging the first walldefining the selected one of the apertures in the first plate.
 5. Theguide device of claim 2, wherein the first arm is pivotable about therib to selectively engage the arm with the first wall defining theselected one of the apertures in the first plate.
 6. The guide device ofclaim 5, the first arm further comprising a distal engagement featureand a proximal engagement feature, wherein the rib is longitudinallypositioned between the distal engagement feature and the proximalengagement feature.
 7. The guide device of claim 6, wherein the distalengagement feature comprises an inwardly extending ridge configured toengage the first wall defining the selected one of the apertures in thefirst plate.
 8. The guide device of claim 6, wherein the proximalengagement feature comprises an outwardly curved flange operable topivot the first arm about the rib.
 9. The guide device of claim 1,wherein the first arm is resiliently biased to engage with the firstwall defining the selected one of the apertures in the first plate. 10.The guide device of claim 1, the body further comprising a secondgenerally lateral side extending between the generally proximal side andthe generally distal side, the guide device further comprising a secondarm extending from the second generally lateral side, wherein the secondarm is operable to selectively engage with a second wall defining theselected one of the apertures in the first plate to selectively securethe body to the first plate.
 11. The guide device of claim 10, whereinthe first arm and the second arm are each pivotable relative to the bodyto selectively engage or disengage the first wall defining the selectedone of the apertures in the first plate.
 12. The guide device of claim11, wherein the first arm and the second arm each comprise a proximalend and a flange at the proximal end, wherein the flanges are operableto urge the proximal ends toward each other.
 13. The guide device ofclaim 12, wherein the first arm and the second arm are configured todisengage the first wall defining the selected one of the apertures inthe first plate when the proximal ends are moved toward each other. 14.The guide device of claim 1, wherein the first arm is integrally formedwith the body.
 15. A guide device insertable into a grid plate forguiding a medical instrument relative to a patient, the guide devicecomprising: a. a body defined by a plurality of faces; b. at least onepassageway, wherein the at least one passageway extends from a firstface of the plurality of faces through the body to a second face of theplurality of faces, wherein the at least one passageway is configured toreceive at least a portion of the medical instrument; and c. a first armextending from a third face of the plurality of faces, wherein the firstarm is operable to engage with the grid plate to secure the guide deviceto the grid plate.
 16. The guide device of claim 15, further comprisinga rib coupling the first arm with the third face, wherein the rib spacesthe first arm away from the third face to provide a gap configured toreceive a portion of the grid plate.
 17. The guide device of claim 15,further comprising a second arm extending from a fourth face of theplurality of faces, wherein the second arm is operable to engage withthe grid plate to secure the guide device to the grid plate.
 18. Theguide device of claim 15, wherein the first arm is resiliently biased toengage with the grid plate to secure the guide device to the grid plate,wherein the first arm is pivotable relative to the body to disengagefrom the grid plate.
 19. A method of using a guide device to guide amedical instrument relative to a patient, wherein the guide devicecomprises a distal portion, a proximal portion, an internal passagewayextending from the proximal portion to the distal portion, and a lockingarm, the method comprising: a. positioning a grid plate adjacent to thepatient, wherein the grid plate defines a plurality of apertures; b.inserting the distal portion of the guide device distally into aselected aperture of the grid plate, wherein the locking arm secures theguide device to the grid plate upon insertion of the guide device intothe selected aperture; c. inserting a portion of the medical instrumentdistally into the internal passageway; d. pivoting the locking arm todisengage the grid plate; and e. withdrawing the guide device from thegrid plate with the locking arm pivoted to disengage the grid plate. 20.The method of claim 19, further comprising pivoting the locking arm toprovide clearance for a portion of the grid plate during the act ofinserting.